Wide Variation in the Percentage of Donation After Circulatory Death Donors Across Donor Service Areas - A Potential Target for Improvement

Abstract [from journal]

Background: Substantial differences exist in the clinical characteristics of donors across the 58 donor services areas (DSAs). Organ procurement organization (OPO) performance metrics incorporate organs donated after circulatory determination of death (DCDD) donors, but do not measure potential DCDD donors.

Methods: Using 2011-2016 UNOS data, we examined the variability in DCDD donors/all deceased donors (%DCDD) across DSAs. We supplemented UNOS data with CDC death records and OPO statistics to characterize underlying process and system factors that may correlate with donors and utilization.

Results: Among 52,184 deceased donors, the %DCDD varied widely across DSAs, with a median of 15.1% (IQR [9.3%, 20.9%]; range 0.0-32.0%). The %DCDD had a modest positive correlation with 4 DSA factors: median match MELD, proportion of white deaths out of total deaths, kidney center competition, and %DCDD livers by a local transplant center (all Spearman coefficients 0.289-0.464), and negative correlation with 1 factor: mean kidney waiting time (Spearman coefficient -0.388). Adjusting for correlated variables in linear regression explained 46.3% of the variability in %DCDD.

Conclusions: Donor pool demographics, waitlist metrics, center competition and DCDD utilization explain only a portion of the variability of DCDD donors. This requires further studies and policy changes to encourage consideration of all possible organ donors.